Timor-Leste has just launched its Health Financing Strategy 2019 – 2023, an essential element of progress towards universal health coverage (UHC).
For a country to achieve UHC, it must have a strong finance system in place to collect, manage, and allocate resources for the health sector.
The Health Financing Strategy will ensure financial protection for the population; increase health funding to cover unmet needs such as coverage of essential services; reduce inequities in availability and use of health services; and improve system efficiency.
The Government of TimorLeste launched the Health Financing Strategy with support from the WHO Country Office in Timor-Leste, through the UHC Partnership and by engaging with a range of stakeholders.
The overriding mission of the health system in Timor-Leste is to ensure accessible and affordable health services for all Timorese people. We stand firmly committed to the goals and principles of universal health coverage.
I hope this document will provide the framework and mobilize all efforts of the government, development partners, private sector, stakeholders and communities in contributing towards a sustainable health financing system in Timor-Leste. I invite you all to engage in this process to fulfill our common vision of Healthy Timorese citizens living healthy Timor-Leste.
I sincerely hope that this health financing strategy will ensure that Government health budgeting and expenditures remain compatible with the delivery of health services, both in quantity and quality, to the Timorese population. It is internationally recognised that a strong and resilient health system needs efficient and sustainable health financing.
Timor-Leste is strongly committed to achieving UHC. Recently, the health status of its citizens has improved, with more health services available and better financial protection for its population. However, services coverage is still low. For example, about 73.5% of children are fully vaccinated by the end of 1st year and only 57% of births are attended by skilled personnel. The government faces challenges in maintaining current levels of health funding and securing additional funds for new emerging health challenges such as the rise of non-communicable diseases. Also, there are variations in access to health services between urban and rural, rich and poor, and educated and uneducated populations. The distribution of resources such as personnel, funds, and drugs is closely linked to the distribution of health facilities and not to the population or use of services. These are not small things to overcome, but Timor-Leste is determined to apply a thoughtful and determined approach.
Timor-Leste’s National Health Sector Strategic Plan 2011-2030 is progressing well and orients the country’s health sector in the direction of UHC through better access to health services and financial protection. The plan aims to rebuild health facilities, expand community-based health services, increase the number of medical graduates and launch the health financing strategy and family health service delivery model.
Health finance
While many of the activities in the health sector plan are currently underway, Timor-Leste is proud to
have now launched its health finance strategy. WHO and Ministry of Health organized the Timor-Leste Health Financing Forum on 8th November 2019. The Health Financing Strategy 2019-2023 was launched during this event along with Health Financing Diagnostic Report, National Health Accounts 2013-2017 Summary Report, and a Health Financing Brief (also published in the local language tetun).
A health finance strategy is important for a country to achieve UHC in three main ways. Firstly, it helps a country to mobilize resources through domestic financing and manage any external funds. Then, the pooling of funds - or the accumulation and management of advance payments across households - can provide people with protection from the catastrophic consequences of ill health. Finally, with a good financing strategy, a government can strategically purchase health services through direct provision or contracting. The principle of UHC, to leave no one behind, also means requires targeting resources to remove any financial barriers facing the poorest and most vulnerable people when they need to access priority health services. No one should have to pay for their health care and become poorer as a result.
"The key strength of our health financing system is the large and predominant government participation in health care; with services provided free at the point of delivery and low private expenditure,” said Marcelo Amaral, National Director for Planning and Financial Management, Ministry of Health.
"A strategic approach to sustainable health financing is necessary; not just to secure increased financial resources for health, but to strengthen mechanisms for revenue generation, pooling resources and strategic purchasing in the health sector,” said HE Bonifacio Mau Coli des Reis, Lic. SP, ViceMinister for Health Strategic Development, Ministry of Health
Timor-Leste’s health finance strategy has four main objectives:
■ Ensure financial protection for the population;
■ Increase health funding to cover unmet needs such as coverage of essential services, strengthening of hospital care or investments to tackle financial needs associated with non-communicable diseases and others;
■ Reduce inequities in resource availability and service utilization across territories and population groups; and
■ Improve system allocative and technical efficiency.
The WHO Country Office in TimorLeste, through the UHC Partnership, has provided support to develop the plan in various ways. In 2017, WHO supported the Ministry of Health to carry out a health financing diagnostic study, which was followed by analytical work on options for the health financing policy. This provided crucial input to the development of the strategy. WHO also supported a series of consultations and workshops to finalize the health financing strategy. The WHO Regional Office provided support throughout the process with visit by a Regional Adviser, technical support and review of materials.
"The development of the health financing strategy for Timor-Leste has been an extremely engaging and rigorous process. Prior to the development of the strategy, a comprehensive diagnostic of the health financing system was undertaken and key health financing analytics like the National Health Accounts study were conducted. Based on these and numerous consultations among the government agencies, partners and other stakeholders, the health financing strategy was developed. We appreciate the support of the EU WHO UHC Partnership to develop this health financing strategy,” said Dr. Rajesh Pandav, WHO Representative to Timor-Leste.
Multi-stakeholder engagement
No health sector plan or health financing plan can be developed and implemented alone. Timor-Leste’s
finance plan was developed through engaging with a range of stakeholders including development partners and other Ministries and sectors.
Going forward, the Ministry of Health invites many different stakeholders to engage with the plan, and its implementation. The strategy calls for critical linkages and collaboration between the Ministry of Health and Ministry of Finance to strengthen the public financial management system. Strengthening health planning, and budgeting and implementing the essential service package will also require the capacity and commitment of health professionals and managers. Development partners play a critical role in supporting the government to ensure that health finance is adequate and sustainable. Importantly, civil society can complement the government’s efforts to address the needs of the poorest and most vulnerable parts of the population
Summary
The Ministry of Health in Timor-Leste is working hard to ensure that its whole population has access to health services without becoming poorer as a result. A strategic approach to sustainable health financing is necessary not just to secure increased financial resources for health, but to strengthen mechanisms for revenue generation, pooling resources and strategic purchasing in the health sector. As Timor-Leste takes precious steps towards UHC, how this plan is now implemented will make all the difference to the populations’ health.